Hashimoto’s Thyroiditis

Hashimoto’s Thyroiditis

Of all of autoimmune conditions that we see, Hashimoto’s thyroiditis is one of the most common. As a glandular autoimmune disease (one that affects a specific gland), you will commonly see it occur with other autoimmune diseases. It is also one of the most underdiagnosed autoimmune diseases.

So what is Hashimoto’s? Simply put, it is an autoimmune reaction that stops the thyroid gland from making thyroid hormone. If you don’t know what the thyroid gland is or what it does check out our blog post on how the thyroid works. But this autoimmune reaction can lead to hypothyroidism or low thyroid hormone.

What Happens in Hashimoto’s?

The autoimmune reaction in Hashimoto’s requires at least one of two antibodies to be present. Those antibodies are thyroid peroxidase (TPO) and thyroglobulin (TG). TPO is an antibody that stops iodine from being put into the two thyroid hormones T4 and T3. If you can’t put iodine into the hormones, you can’t make the hormones. Iodine is essential to thyroid hormone production.

Without the ability to put iodine into thyroid hormone, you get a low level of thyroid hormone production. This commonly leads to low T4 levels, since T4 is the main hormone produced in the thyroid gland.

Thyroglobulin (TG) antibodies block a protein called thyroglobulin in the thyroid. This protein is responsible for carrying T4 and T3 to different parts of the thyroid gland to get the things it needs to be made. Think of it like a conveyor belt. It will bring T4 and T3 to all of the places it needs to go to get fully built. If you don’t have this conveyor belt, you can’t make T3 and T4. This also causes a low level of thyroid hormone production.

When thyroid hormone levels are low, your metabolism doesn’t work well. Common symptoms of hypothyroidism are: reduced heart rate, slower breathing, hair loss and brittle nails, fatigue, brain fog, reduced reflexes and many other things.

How do You Diagnose Hashimoto’s Thyroiditis?

Hashimoto’s can be done with simple lab testing. The first set of tests that should be run are to look at regular thyroid function. This will tell you if you are hypothyroid or not. Common labs include TSH, free T4 and free T3. Free T4 and T3 are the hormones in your body that are available to be used by the rest of your body. If these hormones are low, then your body will underperform.

TSH is the hormone that your brain makes that tells your thyroid gland to work. TSH is usually high when thyroid hormones are low. This is because a regulatory mechanism leads to low levels of thyroid hormone to cause the brain to increase its signal to the thyroid to make more thyroid hormone.

The antibodies to the thyroid that cause Hashimoto’s can also be tested in the blood. This is how you distinguish between autoimmune hypothyroidism and regular hypothyroidism. TPO and TG antibodies should always be checked any time that you are diagnosed with hypothyroidism so you know if you have an autoimmune reaction or not.

What is the Prognosis of Hashimoto’s?

When you are diagnosed with Hashimoto’s, the goal in treatment is to make sure thyroid hormone is normal in the body and to try to reduce antibodies. You don’t need antibodies to be zero for the thyroid to work though. Realistically, the lower the antibodies, the better chance your thyroid has at working. Many people with Hashimoto’s can get off of thyroid hormone if they can get their thyroid antibodies low enough.

Helping to reduce antibodies requires identifying triggers to the autoimmune reaction and removing those triggers. This can be tricky and should be done under the guidance of a skilled practitioner. Additionally, iodine should be with caution in those with Hashimoto’s. This can sometimes aggravate the autoimmune reaction if TPO antibodies are high.

Imaging should also be done in those with Hashimoto’s. This can assess if there is any enlargement of the thyroid gland or if there are nodules. Nodules are common in Hashimoto’s and they are benign. But if they are large, or there are too many, they can press on surrounding tissues and cause problems. Imaging is done with an ultrasound machine and is non-invasive and does not expose you to radiation.

If you think that you might have Hashimoto’s, or you were diagnosed with hypothyroidism but want to know if you have Hashimoto’s, you should speak with your doctor. Since blood tests are easy to perform, they can be done any time. If you have questions about how to treat Hashimoto’s or any autoimmune disease, contact our clinic to speak to one of our skilled physicians.

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